Abscess subphrenic

Find out what happens when you have an operation to remove an abscess that's formed in the upper part of your abdomen just under your chest. This is something brought on by infection after, for example, appendicitis, a burst ulcer, or an operation.

The operation

A cut about 3 inches long (8cm) is made in the skin of the tummy as near as possible to the abscess. The cut is deepened until the surgeon reaches the abscess. The pus then drains out to the skin.

The surgeon will also wash out the area of the abscess with a lot of fluid. This fluid sometimes contains medicines, such as antibiotics, to prevent further problems with infection.

A rubber drainage tube is put down into the abscess space to drain out any further pus. This tube stays in place until it is clear from X-ray tests that the abscess space is getting smaller. The tube can then be shortened, bit by bit. Finally the wound dries up and heals over.

Any alternatives?

If you leave things as they are, the abscess may drain out through your skin after many days. You may become very ill and weakened during this waiting time and if left untreated could result in death. Sometimes the abscess drains into the lung or spreads around inside your tummy. These can be very serious for you.

Antibiotics have not done the trick in your case. Draining the abscess is all that should be done at this stage. If there is an underlying disease, this may be done at a later date.

In some cases the drainage tube can be placed in the abscess without an operation. A small area of the skin on top of the abscess is numbed with an injection of anaesthetic (like when you go to the dentist) and a very small (1/2 inch/ 1.3cm) cut is made in this area.

Via the small cut and with the help of special X-rays, the drainage tube will be put into your abdomen and directed into the abscess to allow it to drain through the skin.

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Although this procedure is obviously simpler compared to an operation, it is not always successful and it doesn't work in situations like yours where the liquid pus in the abscess is very thick and therefore doesn't drain freely through the drainage tube.

Before the operation

You may well be in hospital already, so some of the notes below are only for new comers.

Check you have a relative or friend who can come with you to hospital, take you home, and look after you for the first week after the operation.

Sort out any tablets, medicines, inhalers that you are using. Keep them in their original boxes and packets. Bring them to hospital with you.

On the ward, you will be checked for past illnesses and will have special tests to prepare you and make sure you can have the operation safely. Please tell the doctors and nurses of any allergies to tablets, medicines or dressings.

You will have the operation explained to you and will be asked to fill in an operation consent form. Before you sign the consent form, make sure that you fully understand all the information that was given to you regarding your health problems, the possible and proposed treatments and any potential risks. Feel free to ask more questions if things are not entirely clear.

Many hospitals now run special preadmission clinics, where you visit a week or so before the operation, where these checks will be made.

After – in hospital

You will have a drip tube in an arm vein connected to a plastic bag on a stand, containing a salt solution or blood. You may have a fine plastic tube coming out of your nose and connected to another plastic bag to drain your stomach. This is to decompress your stomach which, along with the bowel, may feel a bit sluggish after an operation.

Swallowing may be a little uncomfortable. You will have a rubber drainage tube coming out of your wound. The tube is connected to a plastic bag. There is a dressing on the wound. You may be given oxygen from a face mask for a few hours if you have had any chest problems in the past. The wound is a little painful.

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You will be given tablets or injections to control this. Ask for more pain killers if needed.

Many hospitals are now using what is called PCA (patient controlled analgesia). By pressing a button on a device you can inject painkillers into your bloodstream through a very fine plastic tube that goes into one of the small blood vessels (veins) in your hand. A small computer controls the amount of painkiller that is released and prevents any accidental overdose.

Alternatively, you may have a fine tube in your back through which pain relief can be given to help control the pain. Sometimes, the drainage tube tugs painfully on the skin after three or four days. Ask for more painkillers as needed. A general anaesthetic will make you slow, clumsy and forgetful for about 24 hours. The nurses will help until you can do things for yourself.

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You will be able to get out of bed the day after operation despite some discomfort. You will not do the wound any harm, and the exercise is very helpful for you.

You may be given a blood-thinning injection in your skin once a day to prevent any blood clots in your legs. This can happen in the first few days after the operation until you can move around a bit more. Those clots can be very dangerous because they can 'travel north' through your blood stream to your heart and lungs and cause very serious problems and even death.

You should be able to walk (with the tube and bags) about 25 yards further each day than the day before.

Because of the drainage tube (catheter) in the bladder, passing urine should not be a problem. Sometimes you may feel as if you're leaking, but this is normally down to an irritation of the catheter tube and should soon pass.

Once you can walk about in reasonable comfort, the catheter is taken out. If you cannot pass urine after this catheter is taken out let the nurses know. If this happens you might need to have the catheter re-inserted for a day or two.

A little dark red blood, changing to a yellow liquid after a day or two, may ooze around the drain tube. Once the X-ray tests on the drain tube are all right, the tube is taken out inch by inch over several days. This does not hurt. The wound then heals up in five or six days.

If there is more discharge for a time, a collecting bag can be stuck onto the skin over the wound. Sometimes the tube needs to stay in place for a week or two, while the abscess space inside your body closes down.

You can wash but try to keep the tube and the area of the skin around it dry. Once the tube is out you can wash or bathe normally. Ordinary soap and water are all you need. Salt water is not needed.

You will be given an appointment to visit the outpatient department for a check-up about one month after you leave the hospital. Some hospitals leave check-ups to the general practitioner. The nurses will advise about sick notes, certificates etc.

After – at home

You are likely to feel very tired and need rest for a month or more. It may be one to two months before you are back to your normal strength. You can build up your walking by an extra 50 yards each day.

At first discomfort in the wound will prevent you from harming yourself by lifting things that are too heavy. After two months, you can lift as much as you could before you had the operation. There is no value in trying to speed the recovery of the wound by special exercises before the months are out.

You can drive as soon as you can make an emergency stop without discomfort in the wound, ie after about three weeks.

You can restart sexual relations after three weeks when the wound is comfortable enough. You should be able to go back to a light job after about one month. It may be two months or more before you can return to a heavy job.

Possible complications

Complications can happen because of the original infection and the anaesthetic itself. There is also the chance that other abscesses may have formed, or will be found once the original abscess is drained. The surgeon will talk to you about any procedures before they are done.

In most cases the abscess will eventually heal up and there will be a very small chance that you might need another operation to drain what is left of the original abscess, or any new ones.

You need to bear in mind that a second operation will have a higher chance of complications following an initial attempt to drain the abscess. Every effort will be made to ensure that you are properly prepared and to reduce any further risks.

Aches and twinges may be felt in the wound for up to six months.

General advice

The operation should not be underestimated. Some patients are surprised how slowly they regain their normal stamina – but virtually all patients are back doing their normal duties within three months of leaving hospital.

These notes will help you through your operation. They are a general guide. They do not cover everything.

Also, all hospitals and surgeons vary a little. If you have any queries or problems, please ask the doctors or nurses.

The materials in this web site are in no way intended to replace the professional medical care, advice, diagnosis or treatment of a doctor. The web site does not have answers to all problems. Answers to specific problems may not apply to everyone. If you notice medical symptoms or feel ill, you should consult your doctor - for further information see our Terms and conditions.